| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
1,661 |
1,087 |
$789K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,731 |
2,014 |
$317K |
| D4341 |
|
4,470 |
1,266 |
$305K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,265 |
4,250 |
$271K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,707 |
2,348 |
$246K |
| D1110 |
Prophylaxis - adult |
2,367 |
2,358 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
3,301 |
3,287 |
$192K |
| D0210 |
Intraoral - complete series of radiographic images |
3,160 |
3,149 |
$149K |
| D9430 |
|
3,968 |
3,595 |
$121K |
| D2954 |
|
944 |
711 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,475 |
957 |
$79K |
| D4910 |
|
1,037 |
1,035 |
$79K |
| D1120 |
Prophylaxis - child |
1,817 |
1,810 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,073 |
4,000 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
787 |
604 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,810 |
2,798 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,255 |
4,239 |
$56K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
116 |
112 |
$54K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
101 |
55 |
$48K |
| D0350 |
|
5,000 |
1,955 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,895 |
3,744 |
$46K |
| D3320 |
|
56 |
52 |
$20K |
| D0330 |
Panoramic radiographic image |
515 |
515 |
$15K |
| D3221 |
|
116 |
106 |
$7K |
| D3310 |
|
22 |
13 |
$7K |
| D4342 |
|
136 |
50 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
38 |
$3K |
| D9993 |
|
16 |
16 |
$942.50 |
| D1351 |
Sealant - per tooth |
41 |
12 |
$902.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$873.60 |
| D1310 |
|
19 |
16 |
$667.00 |
| D0272 |
Bitewings - two radiographic images |
54 |
54 |
$648.00 |